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American Journal of Ophthalmology [journal]
- Evaluation of dry eye and meibomian gland dysfunction after cataract surgery. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Feb 18.
To evaluate dry eye and meibomian gland dysfunction after cataract surgery. Design: Prospective observational case series METHODS: Fifty-eight eyes of 48 patients who underwent phacoemulsification were evaluated preoperatively, and at 1 month and 3 months postoperatively. Ocular symptom score, lid margin abnormalities, superficial punctate keratopathy (SPK), tear film break-up time (TBUT), Schirmer test, lower tear meniscus height , depth, and area using Fourier domain optical coherence tomography, meibum expressibility and images of the meibomian glands using meibography were measured.The ocular symptom scores were worse at 1 month and 3 months postoperatively (p < 0.001 and p < 0.001, respectively). Lid margin abnormalities were significantly increased (p < 0.001 and p < 0.001, respectively) and TBUT decreased postoperatively (p < 0.001 and p < 0.001, respectively). Meibum expressibility decreased at 3 months postoperatively (p = 0.016); however, meibography score, SPK, lower tear meniscus height , depth, and area and Schirmer test did not change significantly postoperatively (all p values > 0.05).Meibomian gland function may be altered without accompanying structural changes after cataract surgery.
- Successful treatment of diplopia with prism improves health-related quality of life. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Feb 18.
To report change in strabismus-specific health-related quality of life (HRQOL) following treatment with prism.Retrospective cross-sectional study METHODS: Thirty-four patients with diplopia (median age 63, range 14 to 84 years) completed the Adult Strabismus-20 questionnaire (100 to 0, best to worst HRQOL) and a diplopia questionnaire in a clinical practice before prism and in prism correction. Before prism, diplopia was "sometimes" or worse for reading and/or straight ahead distance. Prism treatment success was defined as diplopia rated "never" or "rarely" on the Diplopia Questionnaire for reading and straight ahead distance. Failure was defined as worsening or no change in diplopia. For both successes and failures, mean Adult Strabismus -20 scores were compared pre-prism and in prism correction. Each of the four Adult Strabismus -20 domains (Self-perception, Interactions, Reading function and General function) were analyzed separately.Twenty-three (68%) of 34 were successes and 11 (32%) were failures. For successes, Reading Function improved from 57 ± 27 (SD) before prism to 69 ± 27 in-prism correction (difference 12 ± 20, 95% CI 3.2 to 20.8, P=0.02) and General Function improved from 66 ± 25 to 80 ± 18 (difference 14 ± 22, 95% CI 5.0 to 23.6, P=0.003). Self-perception and Interaction domains remained unchanged (P>0.2). For failures there was no significant change in Adult Strabismus -20 score on any domain (P>0.4).Successful correction of diplopia with prism is associated with improvement in strabismus-specific HRQOL, specifically reading function and general function.
- Comparison of Long-term Surgical Outcomes of 2-muscle Surgery in Children with Large Angle Exotropia: Bilateral versus Unilateral. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Feb 18.
To evaluate the long-term results of 2-muscle surgery in children with primary large angle exotropia, comparing 10 mm bilateral lateral rectus recession (BLR) with unilateral lateral rectus recession-medial rectus resection (recess/resect).Retrospective case series.Eighty-six children with exotropia of ≥40 prism diopters (PD), who underwent 10 mm BLR (BLR group) or unilateral recess/resect procedure (RR group) based on the largest angle measured at distance or near were included. Patients were followed up for more than 2 years. Final successful alignment rates, stereopsis, and factors related to recurrence and overcorrection were evaluated.At the final examination, 29 (60.4%) of 48 patients in the BLR group achieved successful alignment, 16 (33.3%) had recurrence, and 3 (6.3%) had overcorrection. In the RR group, 26 of 38 patients (68.4%) were successfully aligned, 10 (26.3%) had recurrence, and 2 (5.3%) had overcorrection. Successful alignment and recurrence rates were not significantly different between the groups (P = .371 and .640, respectively). The overcorrection rate was significantly higher in the RR group (P = .014) until 2 years after surgery, but this difference was not significant afterwards (P = 1.000). In patients with an exodeviation of ≥45 PD, recess/resect procedure showed higher successful alignment rates at the final examination (P = .006).The long-term successful alignment rate of 2-muscle surgery in children with primary large angle exotropia was 64.0% and the overall surgical outcomes were comparable between BLR and RR groups. However, in patients with exotropia of ≥45 PD, unilateral recess/resect procedure resulted in more favorable long-term outcome.
- Wavefront-Guided Versus Wavefront-Optimized Laser In Situ Keratomileusis for Patients with Myopia: A Prospective Randomized Contralateral Eye Study. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Feb 19.
To compare the clinical outcomes of wavefront-guided and wavefront-optimized laser in-situ keratomileusis (LASIK).Prospective, randomized, fellow-eye controlled METHODS: SETTING: Single academic institution STUDY POPULATION: 110 eyes of 55 patients with myopia with and without astigmatism INTERVENTION: One eye was randomized to undergo wavefront-guided LASIK by the AMO Visx CustomVue S4 IR excimer laser system while the fellow eye received wavefront-optimized LASIK by the Alcon Allegretto Wave Eye-Q 400 Hz excimer laser system. Corneal flaps were constructed using the Intralase FS 60 Hz femtosecond laser. Patients were followed at postoperative months 1, 3, 6 and 12.Uncorrected visual acuity, stability of refractive correction, contrast sensitivity, wavefront aberrometry.12 months after LASIK more eyes achieved visions of 20/12.5 or better (30 eyes, 56%) in the wavefront-guided group compared to those receiving wavefront-optimized treatment (22 eyes, 41%) (P = 0.016). Average spherical equivalent refractions were -0.13 ± 0.46 D in wavefront-guided eyes while wavefront-optimized eyes were -0.41 ± 0.38 D at 12 months. Wavefront-guided eyes also achieved better best-corrected visual acuity (BCVA) at both the 5% and 25% contrast levels (P = 0.022 and P = 0.004, respectively). There were no differences in levels of residual astigmatism (P = 0.798) or in higher order aberrations (P = 0.869).Both wavefront-guided and wavefront-optimized treatments are able to safely and effectively correct myopia with and without astigmatism. However, wavefront-guided treatment platforms appear to offer significant advantages in terms of residual refractive error, uncorrected distance acuity, and contrast sensitivity.
- The Argus II Retinal Prosthesis: Twelve-Month Outcomes from a Single-Study Center. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Feb 19.
To study the anatomical and functional outcomes of Argus II Retinal Prosthesis System implantation in retinitis pigmentosa patients.Interventional case series METHODS: STUDY POPULATION: Six patients with a visual acuity no better than light perception.After the Argus II Retinal Prosthesis System was implanted, complications, and anatomical and functional results were studied.Mobility, square localization, direction of motion, grating visual acuity, and Goldmann visual field were assessed. Optical coherence tomography was performed.Implantation of the Argus II Retinal Prosthesis System was safely performed in all patients. One patient experienced postoperative elevation in intraocular pressure, which was controlled medically. In one patient, moderate detachment of the choroid occurred postoperatively, which resolved spontaneously. One patient withdrew from the study. Wound dehiscence, endophthalmitis, or retinal detachment was not observed. All patients were able to locate a bright light on the ceiling and a dark line on the floor after the surgery. Performance in square localization tests improved in 4 patients, and direction of motion improved in 3 patients. One patient achieved grating visual acuity. Goldmann visual field test results improved in all patients.The patients showed an improvement in visual tasks after the surgery, and the device was well tolerated and functional over a 1-year follow-up period. A rigorous patient selection process is necessary to maximize patient compliance with the rigorous follow-up testing schedule. Both patients and medical staff should be prepared for a lengthy, arduous rehabilitation process.
- Assessment of a rapid method to determine approximate visual acuity in large surveys and other such settings. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Feb 15.
To evaluate the efficacy of an iPod™ application developed to rapidly measure approximate visual acuity (VA).Prospective, cross-sectional study.104 subjects (104 eyes) with a wide range of VA underwent both Early Treatment Diabetic Retinopathy Study (ETDRS) VA testing and iPod™ application testing. The application presented 4 randomized ETDRS letters at the Snellen equivalent of 20/40 and 20/200 each. In separate analyses, sensitivity and specificity of the iPod™ test were determined using the ETDRS VA testing results as the gold standard and defining "failure" to see as identifying one, two, three or all four letters incorrectly out of four trials. The minimum number of iPod™ trials necessary to maintain high accuracy was determined by defining a "failure" as getting the first, first two, first three or all trial letters incorrect. In 13 subjects, the time necessary to perform the testing was determined.Forty-six subjects had an ETDRS Snellen equivalent VA≥20/40; 45 had a VA<20/40 and ≥20/200; and 13 had a VA<20/200. The mean±SD testing time for the three groups was 43±13, 60±15 and 72±25 seconds, respectively. The highest sensitivity and specificity combination was observed when a "failure" was defined as getting all letters incorrect for both the 20/40 (sensitivity=98.3%/specificity=93.5%) and 20/200 (sensitivity/specificity both 92.3%) cutoffs.An iPod™ application requiring about a minute testing time provides an objective, portable, rapid and low-cost method to determine approximate VA, allowing VA testing to be performed efficiently in large surveys and other settings where approximate VA should be measured.
- Proton Beam Therapy of Parapapillary Choroidal Melanoma. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Feb 15.
To analyze the functional outcome with regard to the development of visual acuity and radiation induced optic neuropathy of patients with parapapillary choroidal melanoma treated with proton beam therapy.Clinical case series, retrospective study METHODS: We evaluated 147 consecutive patients with parapapillary choroidal melanoma who received proton beam therapy as primary tumor treatment at the Helmholtz Center in Berlin from 1998 to 2005. A cumulative dose of 60 Cobalt Gray Equivalents (CGE) was delivered to the tumor and the optic disc received a minimum of 50 CGEs. Kaplan-Meier analysis was used to assess ocular outcome and survival rates. For trend analysis of functional development, Wilcoxon-Mann-Whitney-U test was used to compare the medians of two groups and Kruskal-Wallis test was used in the case of more than two groups.The mean follow-up time was 6.5 years (range 0.3-11.7 years). The most common side-effects were radiation-induced optic neuropathy, retinopathy, and cataract. The median visual acuity before and within the first year after therapy was 0.4 logMAR (20/50), lapsing to 1.3 logMAR (20/400) after three years and 1.4 logMAR (20/500) after five years. During follow-up, no light perception developed in 17 cases (11.6%), mostly attributed to radiation-induced retinopathy, optic neuropathy and secondary glaucoma. Enucleation was carried out in 14 patients (9.5%) due to local recurrence or severe side-effects.Radiation-induced optic neuropathy is an expected issue after proton beam therapy of parapapillary choroidal melanoma, and visual impairment is common during long-term follow-up, but some useful vision can be preserved in a considerable number of patients.
- Outcomes of Glaucoma Reoperations in the Tube Versus Trabeculectomy (TVT) Study. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Feb 13.
To describe the incidence and outcomes of reoperations for glaucoma in the Tube Versus Trabeculectomy (TVT) Study.Cohort study of patients in a multicenter randomized clinical trial.The TVT Study enrolled 212 patients with medically uncontrolled glaucoma who had previous cataract and/or glaucoma surgery. Randomization assigned 107 patients to surgery with a tube shunt (350-mm(2) Baerveldt glaucoma implant) and 105 patients to trabeculectomy with mitomycin C (0.4 mg/ml for 4 minutes). Data were analyzed from patients who failed their assigned treatment and had additional glaucoma surgery. Outcome measures included intraocular pressure (IOP), use of glaucoma medications, visual acuity, surgical complications, and failure (IOP > 21 mm Hg or not reduced by 20%, IOP ≤ 5 mm Hg, additional glaucoma surgery, or loss of light perception vision).Additional glaucoma surgery was performed in 8 patients in the tube group and 18 patients in the trabeculectomy group in the TVT Study, and the 5-year cumulative reoperation rate was 9% in the tube group and 29% in the trabeculectomy group (p = .025). Follow-up (mean ± SD) after additional glaucoma surgery was 28.0 ± 16.0 months in tube group and 30.5 ± 20.4 months in the trabeculectomy group (p = .76). At 2 years after a glaucoma reoperation, IOP (mean ± SD) was 15.0 ± 5.5 mm Hg in the tube group and 14.4 ± 6.6 mm Hg in the trabeculectomy group (p = .84). The number of glaucoma medications (mean ± SD) after 2 years of follow-up was 1.1 ± 1.3 in the tube group and 1.4 ± 1.4 in the trabeculectomy group (p = .71). The cumulative probability of failure at 1, 2, 3, and 4 years after additional glaucoma surgery was 0%, 43%, 43%, and 43% respectively in the tube group, and 0%, 9%, 20%, and 47% in the trabeculectomy group (p = .28). Reoperations to manage complications were required in 1 (13%) patient in the tube group and 5 (28%) patients in the trabeculectomy group (p = .63).The rate of reoperation for glaucoma was higher following trabeculectomy with mitomycin C than tube shunt surgery in the TVT Study. Similar surgical outcomes were observed after additional glaucoma surgery, irrespective of initial randomized treatment in the study.
- Retinal Microstructural Changes in Eyes with Resolved Branch Retinal Vein Occlusion: An Adaptive Optics Scanning Laser Ophthalmoscopy Study. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Feb 13.
To assess macular photoreceptor abnormalities in eyes with resolved branch retinal vein occlusion (BRVO) using adaptive optics scanning laser ophthalmoscopy (AO-SLO).Prospective observational cross-sectional case series METHODS: After complete resolution of macular edema and retinal hemorrhage, 21 eyes (21 patients) with BRVO underwent full ophthalmologic examination and imaging with optical coherence tomography (OCT) and a prototype AO-SLO system. Cone density and spatial mosaic organization were assessed using AO-SLO images.Regular parafoveal cone mosaic patterns were clearly visualized with the prototype AO-SLO imaging system in the BRVO-unaffected side. However, in the side of retina previously affected by the BRVO, cone mosaic patterns were disorganized and dark regions missing wave-guiding cones were apparent. Additionally, retinal capillaries were dilated, no longer had a uniform caliber, had less direct paths through the retina. In the affected side, parafoveal cone density was significantly decreased, compared with the corresponding retinal area on the unaffected side (P < .001). Furthermore, the hexagonal Voronoi domain ratio and the nearest-neighbor distances were significantly lower than in the unaffected side (P < .05). These parameters were also correlated with photoreceptor layer integrity in the parafovea.After BRVO-associated retinal hemorrhage and macular edema resolved, affected parafoveal cone density decreases and the cone mosaic spatial arrangement is disrupted, becoming more irregular. These cone microstructural abnormalities may extend to parafovea in the BRVO-unaffected side.